Gleaning through the recent privately published and government data makes one thing evident – the issue of maternal health and nutrition requires urgent attention. Aishwarya Panicker, National Consultant, Vitamin Angels, India and Dr Ashutosh Mishra, Senior Regional Technical Director (Southeast Asia), Vitamin Angels, India talks about maternal health nutrition and need of the hour for its strengthening
According to the Global Nutrition Report 2021, the progress made by India in relation to maternal health and nutrition needs to be accelerated. The latest National Family Health Survey (NFHS-5 2019-20) also indicates that the percentage of anaemic women has risen to around 57 per cent, raising concerns. This could potentially be an indicator for a high number of women suffering from malnutrition and its associated ailments. Maternal well-being is an important issue to be addressed as it is directly linked to the intergenerational cycle of malnutrition. In other words, the prevalence of any form of malnutrition in mothers has a direct link with the health of the child. Those children that are born under these circumstances are likely to be impacted through their lifetime in the absence of critical interventions. The Global Burden of Disease 2019 report notes that malnutrition continues to be the primary risk factor driving death and disability in India. Especially for mothers, the lack of access to nutritious foods, financial dependency on earning-head of the household, and lower decision-making power only compounds the issue. The prevailing conditions due to the ongoing COVID-19 pandemic may have further magnified the problem.
The government, in the last couple of years, has set ambitious targets towards eliminating malnutrition in the country. For instance, the Prime Minister launched the POSHAN Abhiyaan in 2018 to improve nutritional outcomes of children, and pregnant and lactating mothers, is bringing focused attention towards this population segment. NFHS-5 shows slight improvement in indicators like stunting and wasting of under-five children. However, for maternal health in particular, an overall analysis of budgetary allocations in this area indicates a stagnancy in the allocation of funds.
India’s total public health expenditure (including state spending) has so far plateaued in the range of 1.2 per cent to 1.6 per cent of the GDP from 2008 to 2020, while in 2021-22 public health expenditure increased for the first time to 2.1 per cent of the GDP. This is a welcome sign and closer to what has been laid out by the National Health Policy 2017 (2.5-3 per cent). However, we see little to no change in the total funds particularly allocated to meet the nutritional needs of women and children.
The newly launched Saksham Anganwadi and POSHAN 2.0 (an umbrella programme for the Integrated Child Development Services (ICDS) scheme, POSHAN Abhiyaan, and Scheme for Adolescent girls) of the Union Ministry of Women & Child Development includes six critical services — supplementary nutrition, preschool non-formal education, nutrition and health education, immunisation, routine health check-ups, and referral services — that are offered as a package. These services have an immense potential as they offer a comprehensive package of micronutrient supplements (like, Iron Folic Acid supplementation), take-home rations, and hot cooked meals to pregnant and lactating women, adolescent girls and children. However, the scheme has also witnessed a slight change from estimated allocations of Rs 20,105 crores (revised estimates were Rs 19,999 crores) in 2021-22 to Rs 20,263 crores in 2022-23. Such a minimal change in investment on nutrition services could have a long-lasting impact on the vulnerable segments who rely on the government provisions through these services.
According to a Budget Brief launched by Avani Kapur and Ritwik Shukla at Accountability Initiative, calculations show that at full coverage, around INR 42,033 crores (multiplying the estimated target population by the government defined unit cost) are required for Supplementary Nutrition needs, which is concerning.
If previous year trends are seen, there has been a decrease in overall allocations even in the sub-components of these schemes. For example, POSHAN Abhiyaan in FY 2020-21 was allocated Rs 600 crores, a huge fall from Rs 3,400 crores in FY 2019-2020. Ms. Kapur and Mr. Shukla’s research also shows that release and expenditure for POSHAN Abhiyaan has been low. Since the inception of the scheme, Rs 5,313 crores have been released by the government till FY 2020- 21, accounting for only 53 per cent of the total allocations. Even where funds were released to States and Union Territories, late procurement, disruptions in implementation, and lack of human resources have created impediments to policy implementation. Budget 2022 could have taken cognizance of addressing the existing economic constraints and bringing a new vigour by reducing the allocation-utilisation gaps, particularly towards services that target maternal health and nutrition. The central government must lead the way and encourage state and union territory governments to address the issue in mission mode.
This could also be the year to have renewed public-private initiatives. Over the last few years, and notably during the COVID-19 pandemic, the private sector has shown itself to be a critical ally in this fight through direct nutritional interventions like provision of fortified foods, communication and outreach for awareness, as well as nutritional counselling. According to a 2019 study by Ashoka University on philanthropic spending, data from 2015-16 CSR spending reflects that the largest spend was on education (30 per cent of total CSR funds) followed by healthcare (17 per cent), rural development (10 per cent), and poverty reduction (8 per cent). There is a dearth of more accurate data on private sector spending, but these studies indicate that the private sector is keen to invest in the issues related to health and nutrition, and this is quite encouraging.
Failure to prevent malnutrition before and during pregnancy can have a devastating impact on mothers, and eventually, children. Unsurprisingly, an undernourished mother inevitably gives birth to an undernourished baby, perpetuating an intergenerational cycle of undernutrition. A well-nourished and healthy mother would not only help in breaking this vicious cycle, but also reduce the burden of disease among the population. Increased and targeted spending, more concerted efforts at the state level, building efforts towards a national nutrition surveillance system, and effective public-private partnerships could provide a shot in the arm. In this regard, investments aimed at maternal, infant, and young child nutrition (MIYCN) warrant immediate attention and commitment if we want to achieve sustainable achievements in child survival, growth, and development.
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